What is vaginal bleeding?

Women experience normal vaginal bleeding each month during their menstrual period, which can last anywhere between 1 and 7 days. If you notice blood coming from your vagina at other times, or you are bleeding during your period in a way which makes you concerned, you should arrange to speak to your doctor, since vaginal bleeding can be a sign of infection or other medical issues.

What's 'normal' vaginal bleeding?

So-called 'normal' vaginal bleeding varies widely between women and can be different for you at different stages of your life. Generally, all women experience a menstrual period approximately once a month — approximately every 21 to 35 days — and it lasts between 1 to 7 days.

Teenagers and women approaching menopause are more likely to have irregular periods, meaning that the gap between periods is less than 21 days or more than 35 days, and the length of this gap can change from month to month. It is also common for women aged between 30 and 50 years of age to experience heavy periods. Some types of hormonal contraception can also cause the frequency and heaviness of your periods to change, as can big changes in your life such as leaving home or breaking up with your partner. Sometimes stressful life events can cause you to skip a period entirely.

Bleeding between periods is very common — in fact, it happens to most women at some point during their lives. However it is not considered normal to bleed frequently in one month, or to bleed between your periods for several months. Bleeding after having sex should always be discussed with your doctor, regardless of your age. There are many possible causes for bleeding between periods and most of them aren’t serious, but you should speak to your doctor if you bleed between periods as it can occasionally signal something serious.

If you bleed from the vagina at any time during pregnancy, you should always immediately contact your midwife or doctor.

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How can I know if my period is too 'heavy'?

It can be difficult to know whether you have normal menstrual (period) bleeding or if your period is too heavy. Your period shouldn’t interrupt your daily activities such as going to school or work, nor should it make you feel stressed or anxious. Signs that you may be bleeding too heavily during your period include:

• having to change your tampon or pad every hour
• bleeding or 'flooding' which is not contained by a thick pad
• having to change your pad during the night
• bleeding for more than 8 days
• passing clumps of blood bigger than a 50-cent piece

If you are concerned that your period is too heavy, you should speak to your doctor to help you work out the cause of your heavy bleeding and to seek solutions.

What causes vaginal bleeding between periods?

A lot of things can cause bleeding between periods, including changes to your hormone levels, using hormonal contraception and infections. It is also common for women to bleed slightly around 10 to 14 days after their period, when an egg is released from the ovary since this causes hormone levels to change. This is sometimes called 'spotting' because the bleeding is generally very light. If you notice bleeding between your periods more than once or twice, you should speak to your doctor to check if this needs to be investigated.

When should I see a doctor about vaginal bleeding?

It is very common to bleed occasionally between your periods, but if it happens more than once or twice, you should see your doctor. You should make an appointment with your doctor right away if:

• your periods seem too heavy
• you are older than 45 years and experiencing vaginal bleeding between periods
• you bleed after having sex
• you feel unwell, sick or dizzy because of your period
• you have an unusual vaginal discharge along with your period
• you have a fever or experience pain with your period
• there is a chance you could be pregnant
• you are post menopausal

If are worried about talking about women’s health or describing your periods, consulting a female doctor in your age group may help you feel more comfortable. It may help to bear in mind that periods are a part of all women’s lives, and that vaginal bleeding is a concern that affects most women at some point in their life.

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When does vaginal bleeding need further investigation?

Vaginal bleeding which happens more than once or twice outside your period or that makes you feel unwell should always be investigated.

Your doctor may ask you about your general health and the nature of your periods. They may also ask whether you could be pregnant. In some cases, a very early miscarriage or an ectopic pregnancy (when a fertilised egg grows outside of the womb) can cause vaginal bleeding without you ever knowing that you were pregnant.

Your doctor might feel your tummy, do an internal examination to check your vagina and look at your cervix using a medical device called a speculum. They may also swab your vagina to test for infections and take a cervical screening test to see if there are any changes in your cervix. You doctor may also ask you to do a pregnancy test or go for an ultrasound so that they can better understand the health of your cervix and uterus.

The ultrasound can be done through your tummy wall or from inside your vagina. Although this sounds uncomfortable, most women prefer vaginal ultrasounds to an ultrasound through the tummy wall which requires a full bladder. You doctor may also refer you to a gynaecologist, who is a medical doctor who specialises in women’s health.

How can I treat vaginal bleeding between periods?

If your doctor has diagnosed the cause of your bleeding, you can treat the bleeding by following their advice, such as by taking a course of antibiotics if you have an infection, or by changing to a different form of contraception if the bleeding is caused by the contraception you have been taking. If the bleeding is light and isn’t bothering you, it may not be necessary to do anything at all.

If you have not yet discussed your vaginal bleeding with your doctor, its important you make an appointment to do so, as vaginal bleeding cannot be treated at home without knowing the cause.

Until you see your doctor, using a larger tampon or pad can help you feel more comfortable if you are experiencing heavy bleeding. If you find that you need to change it very frequently, it is important you tell your doctor, since this can be sign that your period flow is heavier than normal.

Frequently asked questions

How can I treat vaginal bleeding caused by a sexually transmitted infection?

If your doctor has diagnosed that your bleeding is because of a sexually transmitted infection (STI) your partner also needs to be treated otherwise you will continue to reinfect each other. STIs can also cause unusual or increased vaginal discharge which will also go away after the infection has been treated. If the infection is thrush (candida ), your partner may not need treatment as just treating you is enough.

Can medications cause vaginal bleeding?

Some medications, such as anticoagulants (including ‘blood thinners’ such as warfarin) can make you more likely to bleed. If you are taking an anticoagulant and are experiencing vaginal bleeding, you should speak to your doctor right away. Do not stop taking any prescribed medication unless instructed to do so by your doctor.

Hormone replacement therapy (HRT) after menopause can sometimes cause irregular bleeding. This is not a cause for concern and should settle down after several months.

Abnormal vaginal bleeding is also common when you start using hormonal contraception (for example, oral contraceptive pills or an intrauterine device). If it does not go away or is bothering you, talk to your doctor.

Abnormal bleeding can also occur when you change or stop your hormonal contraception.

Resources and support

• Use the period pain and symptom diary provided by Jean Hailes to help you manage and understand your periods. This can be a useful tool when describing irregular bleeding to your doctor.
• Watch this short video about heavy menstrual bleeding from Jean Hailes.
• Learn more about what to expect during menopause on the Hormones Australia website.